WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...

PART I. REVIEW OF SCIENTIFIC DATA RELATED TO HAND HYGIENE
geographical locations and respective climate conditions, and
individuals.
For HCWs at risk of irritant contact dermatitis or other adverse
reactions to hand hygiene products, additional skin moisturizing
may be needed. Hand lotions and creams often contain
humectants, fats, and oils that increase skin hydration and
replace altered or depleted skin lipids that contribute to the
barrier function of the skin. 576,622 Several controlled trials have
shown that regular use of such products can help prevent
and treat irritant contact dermatitis caused by hand hygiene
products. 623-627
Importantly, in a trial by McCormick and colleagues, 624 improved
skin condition resulting from the frequent and scheduled use of
an oil-containing lotion led to a 50% increase in hand cleansing
frequency among HCWs. These investigators emphasized
the need to educate HCWs regarding the value of regular,
frequent use of hand-care products. However, most hand
moisturizing agents are not sterile and thus may easily become
contaminated; they have been associated also with outbreaks
in the neonatal ICU setting. 628 In particular, if the lotion is poured
from a large bottle into smaller bottles, the smaller containers
should be washed and disinfected between uses and not
topped up.
Recently, barrier creams have been marketed for the
prevention of hand hygiene-related irritant contact dermatitis.
Such products are absorbed into the superficial layers of
the epidermis and are designed to form a protective layer
that is not removed by standard hand cleansing. Evidence of
the efficacy of such products, however, is equivocal. 623,624,629
Furthermore, such products are expensive, so their use in
health-care settings, particularly when resources are limited,
cannot be recommended at present. Whether the use of basic,
oil-containing products, not specifically manufactured for hand
skin protection, would have similar efficacy as currently available
manufactured agents remains to be determined.
Frequent wearing of gloves can increase the risk of skin
problems. In a study among healthy volunteers, when a
moisturizer was applied prior to wearing occlusive gloves, there
was a statistically significant improvement in skin hydration. 630
More recently, an examination glove coated with aloe vera
resulted in improved skin integrity and decreased erythema in
30 women with occupational dry skin. 631 Nevertheless, such
products cannot yet be recommended as field trials, larger
sample sizes, and cost analyses are needed.
In addition to evaluating the efficacy and acceptability of handcare
products, product selection committees should inquire
about potential deleterious effects that oil-containing products
may have on the integrity of rubber gloves and on the efficacy
of antiseptic agents used in the facility, 204,632 as well as the fact
that, as previously mentioned, most of these products are not
sterile and can easily become contaminated.
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